26 November 2012 6:30 PM

The coalition's inability to review the IDTS prison methadone programme is fundamentally wrong

Will Self was quite right last week to condemn the practice of doping prisoners with methadone instead of putting them onto abstinence programmes. As a former and recovered heroin addict, he is better placed than most to know the difference between treatment that works and treatment that harms.

He was naive, however, to put this practice down just to ‘well-meaning doctors who have no alternative because it’s all they know how to do’.

Well-meaning doctors are doing this because this is the government’s policy. They don’t have much latitude - ignorant or otherwise. It is the government more than doctors who must take the wrap for the 60,000 plus prisoners (in any one year) who are, in medical parlance, ‘clinically managed on methadone’ or in common parlance, ‘doped up’.

Government is the culprit – prisons are awash with methadone as a consequence of government policy.
The simple fact is that last two Labour governments under the euphemism of an ‘Integrated Drug Treatment System’ (or IDTS) pumped the green synthetic opiate substitute into prisons in four planned ‘waves’ or ‘roll outs’ over three years.

It was a classic example of Labour’s targeted, process driven, people managed and ultimately disastrous approach to problem solving.
It was designed to mirror their equally (in the name of harm reduction) target driven ‘community’ mass methadone dispensing programme. In the prison system they found an accessible and powerless population on whom this could be quickly imposed.

In the NHS – newly responsible for prison drug treatment - they found the bureaucrats willing to impose it, often on reluctant prison officers and governors. Brand new IDTS development managers appointed to manage and coordinate it from Regional Health Authorities down to Primary Care Trusts and into prisons added to an oppressive bureaucracy. No stone was left unturned.

Nothing stood in the way of this £106 million intervention. Prison staff who expressed serious reservations – whether about the ligature points conveniently provided by the new cell door methadone ‘hatches’, about the leakage of methadone into the illicit prison drug market, about prison management revolving around methadone dispensing, or about the hostile environment of a prison ‘methadone culture’ for rehabilitation - were treated as hostile, uncooperative or even reactionary.

Yet, as an initial independent evaluation of the scheme revealed, they had good reason.

Instead of listening to their concerns, in 2008 the government announced a new biometric-based computer controlled methadone dispensing system for prisons (CCMDS) contract – a nice little earner for NEC UK and for Methasoft UK Ltd, the companies to win it – to act as a cure all and to prevent unauthorised usage.

But it was not long before former inmates and drugs workers described CCMDS as a joke in a culture where prisoners were bullied into regurgitating the green gloop – a culture the Department of Health seemed blind to or unaware of.

Soon too, former Chief Inspector of Prisons, Anne Owers, was to criticise STYAL, the women’s prison, for running a regime focused around methadone dispensing and for its lack of a proper detoxification programme. Yet such regimes were fast becoming the norm across all British prisons.

By the autumn of 2009, it was clear that inmates on this heroin substitute had little chance of being weaned off. The Centre for Policy Studies obtained figures from the government which showed a huge increase in the number of prisoners on methadone "maintenance" programmes. In one year it rose by 57% ( 12,518 in 2007 to 19,632 a year later,). There was no other explanation for this other than the IDTS ‘roll out’.

It emerged too that methadone programmes were misleadingly being described as detoxification when the reality was quite the reverse. Prisoners were simply swapping one illicit addictive drug for another licit one.

At the same time the ready availability of methadone had closed their final route to getting clean in prison which despite its harshness, many addicts and users still valued – cold turkey.

It was abundantly clear that the government had created a huge new social problem and that no comparable money was going into alternative, abstinence programmes.

By contrast to the thousands of on methadone, the CPS found out that only 850 prisoners had been placed the previous years on a 12-step detoxification programme.

Mark Johnson, a former addict and offender, now dedicated to prisoner rehabilitation, wrote in his Guardian column that the system was a human rights abuse.

Prison, as a huge residential institution, he opined, was the best opportunity addicts or users had of getting off drugs.

He could not believe its misuse.

Two years later, it is still misused. The sad fact is that there are no more intensive abstinence based programmes in prisons now than 12 years ago.

So why is it that the Coalition Government, for all its rehabilitation rhetoric, has not even reviewed the IDTS prison methadone programme, let alone retracted it?

Perhaps as Mark wrote it is because, “Drugs keep the wings quiet, after all ... the seriously addicted are supplied with methadone on prescription, the habits of others are uninterrupted.”

But the downside as he says is the loss of a golden opportunity for abstinence-based residential treatment.

Will Self hopes that the past few years have seen something of a sea change in thinking about rehabilitation. That may be. But the sad truth is that the Coalition Government has shown no more appetite for investing in the necessarily abstinence based rehabilitory regimes than its predecessors.

There is still only the same handful of AA and NA inspired 12-step RAPT prison programmes that provide the most solid model for reducing reoffending that there were twelve years ago. The Coalition has shown no more interest than Labour in replicating them across the estate.

Just last week, instead of addressing this profound problem, the Justice Secretary, Chris Grayling put his hopes on another doubtful process managed system. ‘The rehabilitation revolution’, he announced, ‘will be built around payment by results’.
I somehow doubt it.

The outsourced post prison ‘rehab’ courses he advocates should not be mistaken for and cannot replicate the intensive abstinence-based rehabilitation that's really required.

Nor is there evidence yet that ‘PBR’ works or that the companies contracted to deliver these results have any track record in challenging either addiction or habitual drug use.
The Coalition would be better to put its money where its mouth is.

First, unless they set strict limits on prison methadone dispensing, any rehab will be scuppered from the start.

Second, instead of risking PBR outsourcing the Coalition should start to invest in the rehabs that really have the skill and the expertise do the job for them - like the Providence Projects or RAPT - proper rehabs with proven track record in turning around lives, that recovered addicts and rehabilitated offenders swear by and are the living proof of.

When I see that I happening and only then will I share Will Self’s sea change optimism.

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